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Sudden sensorineural hearing loss — MCCQE Part 1 MCQ

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HardHearing LossSudden sensorineural hearing lossMCCQE Part 1

55-year-old woman presents with sudden unilateral hearing loss on waking. Weber lateralises to the opposite ear and otoscopy is normal. Which of the following is the most appropriate next step?

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Correct answer: C — Start urgent corticosteroid pathway and refer urgently to otolaryngology/audiology

Start urgent corticosteroid pathway and refer urgently to otolaryngology/audiology is best because sudden sensorineural hearing loss is time-sensitive and may benefit from early steroids. Discharge with reassurance and routine follow-up only is suboptimal because it underestimates acute or progressive risk; Treat symptomatically and defer definitive assessment is suboptimal because symptom control alone does not address the likely underlying diagnosis; Arrange non-urgent outpatient imaging in several months is suboptimal because delayed imaging is unsafe when the presentation has red flags; Start long-term corticosteroids without confirming the diagnosis is suboptimal because empiric steroids can obscure infection, malignancy or other diagnoses. Do not treat normal-otoscopy sudden hearing loss as wax.

Reference: Canadian otolaryngology guidance